Within minutes, you were reading stories about infertility, not getting decent healthcare, and a future filled with fertility treatments. Your heart probably sank as you started mentally rewriting your life plans.
Take a deep breath. Your story isn't over before it's even begun.
The internet (and even some doctors) often equate PCOS to infertility, but PCOS doesn't mean that everyone with PCOS will struggle with fertility. It also doesn't mean that you can't take measures to improve your chances of success! You totally can!
Honestly? These things are true for a LOT of people, PCOS or not.
Polycystic ovary syndrome is incredibly common (affecting up to 10% of reproductive-aged people), and many people with PCOS go on to have healthy pregnancies—some naturally, some with meds, some with fertility treatments, some after a lot of effort, and some with not much effort at all.
Here are some of the factors that can come into play when we're looking at PCOS fertility:
You may not be ovulating. No ovulation = no egg release = can't conceive.
You may be ovulating irregularly. Irregular ovulation = irregular cycles and random egg release times = don't know when to time intercourse to conceive.
Insulin resistance, high androgens like testosterone, higher levels of fat tissue around your organs, and metabolic dysfunction all play into one another affecting not only the chance to get pregnant, but also early placental development and pregnancy complications like gestational diabetes, gestational hypertension, and poor fetal growth.
Egg quality: people with PCOS can have poorer egg quality due to a combination of factors.
There can also be other things going on if you have PCOS. For example, vitamin D deficiency is common in PCOS and can affect fertility. Thyroid disease is associated with PCOS and can affect your efforts to try to conceive and have a healthy baby as well.
I know this can seem a bit bleak. BUT there are things we can do! From nutrition and supplementation to meds and fertility treatment (and everything in between!), we can do a lot for your PCOS and fertility.
Forget everything you've heard about cutting carbs, going keto, or removing all gluten (unless you have Celiac disease) for PCOS. Your body needs balanced fuel to have a healthy menstrual cycle and to make babies, not diets rooted in deprivation. Focus on:
Protein at every meal (helps with blood sugar stability), ideally not from processed meats or red meats, but lean sources of protein like beans, lentils, and poultry.
Healthy fats (your hormones literally need fat to function), like those from nuts and seeds and ideally not from butter or full-fat dairy.
Complex carbs (yes, carbs are fuel!) like whole grains and those found in lentils, veggies, and beans.
Lots of plants (antioxidants are your fertility friends, especially your purple/blue/red kinds). Plants are also how you'll get fibre, which we don't talk enough about for PCOS! Check out this blog post on fibre.
Eating consistently and adequately is more important than eating "perfectly."
A bit of weight loss, like 5-15% of your starting point, especially if you've put on weight around the abdomen or have historically had a high waist circumference, can be helpful to improve outcomes. So, for someone who is starting off at 200 lb, losing 10 lb is meaningful for fertility!
There's many ways to do this that are beyond the scope of this post, but check out this episode of my podcast, Phase to Phase: The Hormone Health Show, to help you understand why weight loss can be so hard.
Some supplements have solid research behind them for PCOS fertility. Please consult with your naturopathic doctor before adding these in because not everyone with PCOS needs all these supplements and we select a plan based on YOU! Supplements can include things like:
Inositol for insulin resistance, ovulating regularly, and improving egg quality.
NAC: an antioxidant that helps with both insulin resistance and fertility outcomes.
Vitamin D: deficiency is super common in PCOS, so testing and supplementing appropriately is the way to go.
Metformin can be used for insulin resistance, improving ovulation, and even a bit of weight loss.
Letrozole can be used to help with ovulation and paired with timed intercourse.
Weight loss meds can be used prior to conception to improve body composition and restore menstrual cycle regularity and improve metabolic health.
Fertility meds used in timed intercourse, IUI, or IVF. Getting a referral sooner rather than later to get a proper work-up and care is important to set you up for success, especially if you've been trying for more than 6 months and/or have had a pregnancy loss or other complications in the past.
There's no wrong way to exercise apart from not engaging in any physical activity at all (and perhaps if you're really undereating and overdoing it on the exercise!).
For PCOS, the best exercise is the kind you will do! A combination of strength training and cardio helps with insulin sensitivity and stress management. Even regular walks count. Start with something even if it's only a few minutes (but try to work your way up to more!).
Sleep: Your hormones reset overnight. Prioritize it.
Stress management: Chronic stress messes with everything. Find what works for you.
Mental health: A PCOS diagnosis can be overwhelming, as can infertility. Don't go it alone.
Your fertility timeline might look different than someone without PCOS. You might need a few extra months to regulate cycles or try different approaches. That doesn't make you broken. It makes you human with a common (and complex!) hormonal condition that needs some extra attention.
Every month, I see people with PCOS get pregnant. Some quickly, others after more time and support. What they all have in common? They didn't let Google scare them into giving up before they started.
Don't get me wrong, I also see people who have issues with conception and carrying to term. There are always things beyond our control like our past, genetics, etc. BUT there are so many things we can influence on your journey to having a baby.
So, stop googling worst-case scenarios. Find healthcare providers who actually understand PCOS. Be patient with the process while staying proactive.
If you're in Ontario and looking for naturopathic support that combines evidence-based treatments with realistic expectations, I'd love to help you navigate this path with confidence. Book in here (virtual, in Innisfil, or in Newmarket).
